title: Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study.
abstract: OBJECTIVE
  To evaluate the incidence, clinical features, and prognosis of pulmonary complications associated with toxic epidermal necrolysis
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Dermatology intensive care unit in Mondor Hospital, France.
  
  
  METHODS
  41 consecutive patients.
  
  
  METHODS
  On admission, then daily, respiratory evaluation was based on clinical examination, chest X-ray, and arterial blood gas analysis. When clinical symptoms, X-ray abnormalities, or hypoxemia [partial pressure of oxygen (PO2) < 80 mm Hg] were present, fiberoptic bronchoscopy was performed.
  
  
  RESULTS
  10 patients presented early manifestations: dyspnea (n = 10), bronchial hypersecretion (n = 7), marked hypoxemia (n = 10) (PO2 = 59 +/- 8 mm Hg). Chest X-ray was normal (n = 8) or showed interstitial infiltrates (n = 2). In these 10 patients, fiberoptic bronchoscopy demonstrated sloughing of bronchial epithelium in proximal airways. Delayed pulmonary complications occurred in 6 of these 10 patients from day 7 to day 15: pulmonary edema (n = 2), atelectasis (n = 1), bacterial pneumonitis (n = 4). Mechanical ventilation was required in 9 patients. A fatal outcome occurred in 7 patients. Seven patients did not develop early pulmonary manifestations (PO2 on admission 87 +/- 6 mm Hg) but only delayed pulmonary symptoms related to atelectasis (n = 1), pulmonary edema (n = 4), and bacterial pneumonitis (n = 3); bronchial epithelial detachment was not observed. None of them required mechanical ventilation and all recovered with appropriate therapy.
  
  
  CONCLUSIONS
  "Specific" involvement of bronchial epithelium was noted in 27% of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.
authors.affiliation: Hôpital Henri-Mondor, Créteil, France.
authors.forename: F
authors.initials: F
authors.lastname: Lebargy
authors.forename: P
authors.initials: P
authors.lastname: Wolkenstein
authors.forename: M
authors.initials: M
authors.lastname: Gisselbrecht
authors.forename: F
authors.initials: F
authors.lastname: Lange
authors.forename: J
authors.initials: J
authors.lastname: Fleury-Feith
authors.forename: C
authors.initials: C
authors.lastname: Delclaux
authors.forename: E
authors.initials: E
authors.lastname: Roupie
authors.forename: J
authors.initials: J
authors.lastname: Revuz
authors.forename: J C
authors.initials: JC
authors.lastname: Roujeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001980:Bronchi / Q000473:pathology* / Q000503:physiopathology*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000473:pathology / Q000503:physiopathology